27 July

Why we'll never stop HIV while we continue locking people up for transmitting it

'There are 25,000 people at AIDS2012, the same as the number of people living with undiagnosed HIV in the UK. It’s a significant fact because if you don’t know you have HIV you’re far more likely to pass on than someone who does.   It’s why those working in public health promote HIV testing for people at risk of HIV – bring that number down, and you slow the epidemic.'

'There’s a walloping obstacle in their way, and that’s the stigma which allows people with HIV to be put into prison for transmission or even just exposure to the virus in many countries all over the world.

'Think about it: if you feared a prison sentence or a false accusation from a disgruntled ex, would you take the test that removes your defence?

'Research now shows that the fear of prosecution stops many people who believe they might have been at risk of HIV from testing and accessing treatment.

'Let’s be clear – people would rather accept life-threatening consequences than expose themselves to a legal system that many neither understand nor trust.

'Many people with HIV say they are unclear about what behaviour is considered permissible, and what is punishable in their state or country. It varies widely, yet few countries provide clarity

'A man here in the US is serving 20 years for spitting at a police officer, regardless of the fact it is impossible to transmit HIV through spitting. Two decades in prison, for spitting.

'In the UK, Terrence Higgins Trust and others have worked with the Crown Prosecution Service and very few cases are now brought to court. In England and Wales exposure is not prosecuted, only transmission.

'Today, I met American Nick Rhoades who was incarcerated for having consensual sex with a condom. He was on successful treatment which means that even without the condom, it would have been virtually impossible for him to have passed HIV to his partner.

'In jail, he was lumped together with all the other sex offenders – the rapists and paedophiles who are considered the lowest of the low. On release, he is still classed a sex offender, and will be for life.

'Yesterday, the senior politicians from all parties in Norway pledged their commitment to ending the criminalisation of HIV transmission in their country. Until other countries follow suit, their public health professionals will fight a losing battle in their efforts to stop HIV.

'The US tops the list of countries that prosecute offences related to HIV. While the specific offences may vary, the thing that drives every prosecution is stigma and prejudice. As Nick said today “We need a return to sanity, science and justice.”

'And boy, do we need it fast.'

Genevieve Edwards
Executive Director of Communications, Fundraising, and Health Improvement

'To the White House from an International AIDS conference reception with President Barack Obama – an immense privilege to be invited.'

Attended by most members of the US Cabinet , it provided an opportunity for the President and US Government to demonstrate its commitment to HIV. The overall message was the need for the entire world to redouble its efforts to end AIDS, and the President expressed his gratitude to the countless researchers, doctors, nurses, and community-based organisations across the world engaged in the fight against HIV.

The President singled out particular praise and gratitude for people with HIV, and the work that many of us with HIV do everyday to both live with the virus and for those of us involved in the response for all we do to fight the epidemic. He said he wanted to demonstrate his solidarity with people with HIV across the globe.

The reception also provided an opportunity to discuss HIV policy with members of the US Cabinet. I discussed health reform for HIV with the US Secretary of State for Health and Human Services. I also discussed with the US Ambassador to the United Nations the need for continued US leadership to enable a sustained global funding response from across the G7 and major philanthropists.

All in all, an impressive demonstration of the leadership, and an inspiring example of the clear commitment which will be needed for leaders across the world if we’re to have a fighting chance of ending AIDS.

A blog from the White House

'Young people are key to moving towards the goal of an AIDS-free generation and a number of today’s sessions dealt with some of the issues they face. Unsurprisingly, comprehensive sexual, reproductive health and relationship education came out strongly as a need.'

In many African countries, research showed that whilst HIV prevention services and testing opportunities were often widely available, sexual and reproductive health information was far more limited. This is a particular issue for young women and girls, who may have limited power and decision-making abilities within sexual relationships and little or no access to family planning. Many did not even associate condoms with family planning, which poses further problems in relation to HIV prevention efforts, as is evidenced by the data showing that in many countries the rates of HIV infection in young women are double those in young men.

The difficulties of HIV disclosure to partners and anxiety about stigma and discrimination if status was revealed were significant issues for young people and interactive youth-led workshops sought to address some of the issues and provide tools and strategies to facilitate the process and skill young people to manage disclosure in a way that is as comfortable and safe as possible. Of course, stigma is major issue within all populations of PLHIV, reducing internalized stigma was the theme of a session which addressed a range of communities in different countries. Each of the studies found that greater knowledge of HIV reduced fears and anxieties and peer support, either in groups or one-to-one in buddying programs was another successful intervention in addressing feelings of marginalization and isolation.

These issues are inextricably linked to what has arguably been the hottest topic within this year’s conference, the criminalization of HIV transmission, exposure and non-disclosure. A press conference to disseminate the findings of the SERO Project’s National Criminalization Survey was followed by a session examining how punitive laws disincetivize HIV testing, since not knowing one’s HIV status may be a person’s only defense when faced with prosecution. Edwin Bernard of the HIV Justice Network provided an overview of the global picture of HIV-related prosecutions, demonstrating some of the successes that have been made in countries where laws have been changed or are being reviewed, while naming and shaming the countries with the highest number of prosecutions (the USA is top of the list). The rest of the session examined the range of North American experiences of prosecutions, highlighting the wide range of situations where prosecutions are possible, along with the confusion faced by people with HIV as to what might constitute risk. Many of the prosecutions relate to behaviors that do not even transmit HIV (such as spitting), yet are aggressively prosecuted and reported in sensationalist media, comparing HIV exposure to murder, reinforcing the stigma of HIV and discouraging the very behaviors that are needed to bring an end to this epidemic – testing, disclosure and the ownership of both personal and shared responsibility in maintaining good sexual health.

Criminalization was also a theme in the regional sessions on both North America and the Middle East and North Africa, with panelists and audience members challenging governments to address high levels of HIV in key populations by addressing laws on drug use, sex work and MSM. Funding issues were addressed in both regions, with a call for more targeted funding in N America and the difficulty that much of the MENA region has in accessing favorable drug prices, due to the fact that many are considered ‘middle income’ countries. MENA has the lowest uptake of ARV treatment in the world and needs to find ways to address issues that include low rates of HIV testing, poor health infrastructure and problems with drug supply and stockouts. The US must deal with its own issues of ensuring not only that treatment is accessible (and affordable) to all those who need it, but of addressing the issue that only 28% of people with HIV have suppressed viral load.

Underlying and impacting upon all these areas is the need to ensure meaningful community responses to the epidemic, both in terms of support and prevention, and the UNAIDS Investment Framework for the Global HIV Response prioritized community mobilization as a critical enabler in creating successful programs. Real life examples of how to engage communities in advocating for their rights and supporting each other in both driving forward prevention efforts and support programs demonstrated how the GIPA principle (Greater Involvement of People with AIDS/HIV) needs to be put into practice at a community level as well as in holding regional, national and international funders and policy makers to account by including representatives of all our communities at all levels of the HIV response.

Garry Brough
Policy & Public affairs
Membership Officer